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Autism definition to be enlarged as Asperger’s diagnosis disappears

Early next year, a new definition of autism will be used by scientists in order to more precisely diagnose kids with the brain disorder.

The diagnosis of Asperger’s syndrome, considered a “higher functioning” form of autism, will disappear once the new criteria for identifying the disorder come out in May 2013, according to Dr. Catherine Lord, director of the Center for Autism and the Developing Brain. The latter is a collaborative program between New York-Presbyterian Hospital, Weill Cornell Medical College and Columbia University, in partnership with the New York Center for Autism.

The proposed changes on how doctors define and diagnose autism were the subject of a research study conducted by Lord and published in the latest issue of the American Journal of Psychiatry.

“As a scientific medical diagnosis, Asperger’s is merged into autism spectrum disorder,” said Lord. “Our committee felt there just wasn’t any way to justify its continuance.”

Lord is part of the American Psychiatric Association’s working group responsible for updating the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a guide used by physicians around the world. Improved diagnosis leads to better treatment.

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“There was so much confusion of who had Asperger’s and who didn’t. We were also concerned that there were kids being denied services because Asperger’s sounds like a better diagnosis,” she said.

Autism rates are staggering in North America. A debate is currently raging among physicians as to whether or not the rates are actually increasing or if experts have just recently recognized that many social and developmental syndromes are linked.

One in 88 children is believed to have the neurological disorder. Autistic kids can display a range of symptoms from repetitive or aggressive behaviour to a complete lack of social skills and an inability to speak, communicate or make eye contact with others.

Clinicians are scrambling to better define autism in an effort to quickly identify children and get them into interactive, behavioural treatment. There is no cure for autism and the burden on families can be immense as many autistic people cannot live on their own.

Nearly 70 years ago, Austrian pediatrician Hans Asperger was the first to notice in his practice intellectual children with social problems who were somewhat obsessed with specific topics or subjects. These children often avoided eye contact and were clumsy.

But it wasn’t until the 1990s that Asperger’s syndrome was added to the list of the manual of mental disorders. It was noted to be similar but different than autism.

Famous people throughout history thought to have Asperger’s include physicist Sir Isaac Newton, Microsoft founder Bill Gates, British author Jane Austen and movie director Alfred Hitchcock.

Reaction to the changing scope of autism was positive by Canadian doctors working in the field.

There is no biological or genetic reason why Asperger’s should be separated on its own, said Dr. Evdokia Anagnostou, a child neurologist at Holland Bloorview Kids Rehabilitation Hospital.

“We assumed they were different but it looks like they are not,” she said. “Now we can call them all autism.”

Also being swallowed up into the autism spectrum is Pervasive Developmental Disorder, a term used to classify some developmental issues, including the inability to socialize.

Child psychiatrist Dr. Peter Szatmari, a professor at McMaster University and a noted expert on autism, said the changes are a “good thing” as it will speed up the diagnostic progress.

But he cautioned that autism is “incredibly heterogeneous.”

“In 30 years, I don’t think I could say I have seen two cases the same,” he said, adding every child with autism needs his or her own individually tailored treatment path.

“You can’t treat a 2-year-old who is profoundly intellectually disabled and without language as the same as a 7-year-old who is very chatty about their stamp collection,” he said.

“We need a way to capture that diversity,” he said. “This is the part that I am still not clear about.”

People previously diagnosed with Asperger’s should be able to keep that label or name, noted Alycia Halladay, director of environmental research at the U.S.-based Autism Speaks advocacy group.

“The intent is to ensure that people with Asperger’s receive the same needed interventions and services as those with an autism diagnosis,” she said.

The changes being made are the result of “serious consideration by the scientific community,” Halladay said. “There is overwhelming evidence that the new criteria (do) a better job at identifying those people with an autism spectrum diagnosis,” she said.

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